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Privacy Notice

Notice of Privacy Practices

Effective Date: April 14, 2003

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Each time you visit Counseling and Psychological Services (CAPS), a record of your visit is made. This record typically contains medical information about you, including information regarding symptoms, observations, assessments (including test results, diagnoses, treatment, and mental health), a plan for future care or treatment, and billing-related information. This Notice of Privacy Practices (NPP) describes how we may use and disclose your medical information. It also describes your rights and our responsibilities regarding the use/disclosure of your medical information. This NPP applies to all of the records of your care generated or maintained by CAPS.

Our Responsibilities Regarding Your Medical Information

We are required by law to protect the privacy of your medical information, provide you with this NPP, abide by the terms of the NPP currently in effect, and notify you if we are unable to agree to a requested restriction on use or disclosure of your medical information.

Uses and Discolures of Protected Health Information

Uses and Disclosures for Treatment, Payment and Health Care Operations With Your Written Consent.
You will be asked to sign a written consent form enabling us to use and disclose your mental health and medical information for treatment, payment and health care operations as described in this section:

Treatment.
We will use and disclose mental health and medical information about you internally at CAPS to provide and coordinate your health care and any related services. For example, the information will be used by all members of our staff that are involved in your treatment, including but not limited to psychologists, social workers, physicians andstudent mental health professional nurses therapists-in-training, to coordinate the different services you may need. Some student mental health professionals are required to audio tape of video tape some or all of their sessions for purposes of supervision and consultation. No taping will be done unless and until you sign an authorization to record your sessions. Information regarding the progress of your case will be discussed in individual and/or group supervisory or staff meetings and may also be presented in practicum classroom settings for consultation, supervision, or educational purposes. This information will be held in confidence among the CPS staff. In addition, your mental health and medical information may be provided to another health care provider, such as a psychologist, social worker or physician, to whom you have been referred to ensure that they have the necessary information

We will obtain written permission from you when releasing your information to another health care provider outside of CAPS, for example, a psychologist, social worker or physician, to whom you have been referred.

Payment.
We will use and disclose mental health and medical information about you to bill and collect payment from you. We will obtain your written permission prior to using and disclosing information about you to bill and collect payment from your insurance company or a third party payer. If you have any questions regarding the privacy practices of your insurance company or third party payer, you should contact them directly.

Health Care Operations.
We will use and disclose mental health and medical information about you to schedule and coordinate your health care and any related services. We may disclose information to psychologists, social workers, doctors, nurses, psychology and social work interns, and/or practicum students medical students and/or residents for educational purposes.

Members of our staff involved in quality improvement may use information in your mental health record to assess the care and outcomes in your case and others like it. For example, we may analyze medical mental health information about many patients to evaluate the need for new services, resources or treatment and to see where we can make improvements. The results will then be used to continually improve the quality of care for all patients we serve. Therapists-in-training are required to audiotape or videotape some or all of their sessions for purposes of supervision and consultation. No taping will be done unless and until you sign an authorization to record your sessions.

We may also contact you to remind you that you have an appointment, to tell you that your appointment has been cancelled or to let you know that your prescription is ready, to assess your satisfaction with our services, to tell you about health-related benefits or services, or to complete the process of registering you for services.

Other Related Uses and Disclosures.
In addition to the foregoing, we may use and/or disclose mental health and medical information:

To business associates, when we have contracted out for services, so that they can perform the job we've asked them to do and bill you or your third party payer for services rendered;

To a friend or family member who is involved in your care, provided you have given us your permission to do so.

Uses and Disclosures Without Your Consent or Authorization.
In certain situations, we may use or disclose mental health and medical information about you without your consent or authorization. For example, when there is an emergency, a threat to health or safety (consistent with applicable law and standards of ethical conduct), or when there are substantial communication barriers to obtaining consent from you. Further, we may use or disclose your mental health and medical information without your consent or authorization in the following circumstances:

As Required by Law.
We may use and disclose mental health and medical information to the following types of entities, including but not limited to:

Workers compensation agents, when authorized by and to the extent necessary to comply with workers' compensation or other similar programs established by law.

Agencies charged with overseeing the health care system such as state licensing authorities who investigate complaints against health care providers, or administrative agencies that conduct inspections or other activities to monitor health care providers.

Law Enforcement/Legal Proceedings.
We may disclose mental health and health information for law enforcement purposes as required by law or in response to a valid subpoena or other legal process.

Research.
We may disclose mental health and medical information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your mental health and medical information.

Other Uses and Disclosures of Mental Health and Medical Information Based on Your Authorization.
Other uses and disclosures of mental health and medical information not covered by this NPP or by the laws that apply to us, will be made only with your written permission. If you provide us with permission to use or disclose mental health and medical information about you, you may revoke that permission, in writing, at any time.

Your RightsRegarding Your Medical Information

You have the following rights regarding mental health and medical information we maintain about you:

Right To Inspect and Copy.
You have the right to inspect and have copied medical information used to make decisions about your care. Usually, this includes medical and billing records, but does not include some records such as psychotherapy notes restricted psychological test data. Your request must be submitted in writing on a form the CAPS Office will provide to you. We may charge a fee for the costs of processing your request.

Right To Amend.
If you feel that mental health or medical information we have about you is incorrect or incomplete, you may ask us to amend the information. To request an amendment to your record, you must submit your request in writing on a form the CAPS Office ill provide to you. You will be asked to provide a reason to support the request.

Right To an Accounting of Disclosures.
You have the right to receive a list of disclosures. This list will not include all disclosures made. For example, this list will not include disclosures for treatment, payment, health care operations, disclosures made prior to April 14, 2003, or disclosures you specifically authorized. To request this list you must submit your request in writing on a form the CAPS Office will provide to you.

Right To Request Restrictions.
You have the right to request a restriction or limitation on the mental health and medical information we use or disclose about you for treatment, payment or health care operations. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing on a form that the CAPS Office will provide to you.

Right To Request Confidential Communications.
You have the right to request that we communicate with you about mental health and medical matters in a certain way or at certain locations. You must make your request in writing on a form that will be provided to you. We will accommodate all reasonable requests.

Right To A Paper Copy of This Notice.
You have the right to obtain a paper copy of this notice, and you may ask us to give you a copy of this notice at any time. You may obtain a copy of this notice at our website, www.ku.edu/~caps.

You may obtain a copy of the forms mentioned above by contacting the CAPS Office at (785) 864-2277.

Complaints. If you believe your privacy rights have been violated, you may file a complaint with us by contacting the Privacy Officer for CAPS at (785) 864-2277 or by contacting the University's HIPAA Privacy Officer, Lawrence Campus, at (785) 864-9528. You may also contact the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.

Changes to This Notice. We reserve the right to change this NPP and the revised NPP will be effective for information we already have about you as well as information we receive in the future. Should our practices change, we will post a revised NPP on the CAPS website and in the facility where you receive services. Paper copies will be available upon request.

Questions and Information. If you have any questions about this notice, please contact: Privacy Officer, Heather Frost, Ph.D. at (785) 864-2277.

Consent for the Use or Disclosure of Health Information for Treatment, Payment, or Health Care Operations

In our Notice of Privacy Practices, we provide you information about how CAPS can use or disclose your mental health andmedical information. As described in our Notice of Privacy Practices, we request your consent for any use or disclosure of mental health and medical information to carry out treatment, payment or health care operations. You have a right to review our Notice of Privacy Practices before signing the Consent form.